Prognostic value of phospholipase A2 receptor in primary membranous nephropathy: a systematic review and...

Area of Science:

• Nephrology
• Immunology
• Biomarker Discovery

Background:

• Primary Membranous Nephropathy (PMN) is a leading cause of nephrotic syndrome in adults.
• Phospholipase A2 receptor (PLA2R) autoantibodies are key players in the pathogenesis of PMN.
• Predicting remission and treatment response in PMN remains a clinical challenge.

Purpose of the Study:

• To evaluate the prognostic value of serum anti-PLA2R antibodies and glomerular PLA2R deposits (gPLA2R) in predicting proteinuria remission in PMN patients.
• To assess the utility of these biomarkers in anticipating clinical outcomes.
• To determine the predictive power of anti-PLA2R and gPLA2R for response to immunosuppressive therapy.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, EMBASE, Web of Science, Cochrane Library, CNKI) from January 2008 to December 2018.
• Meta-analysis was employed to synthesize data from 29 cohort studies, including 2345 PMN patients.
• Statistical heterogeneity was assessed using Cochran Q test and I-squared statistics, with subgroup and sensitivity analyses to explore sources of variation.

Main Results:

• Negative anti-PLA2R at biopsy was associated with a 1.31-fold higher likelihood of remission compared to positive anti-PLA2R.
• Clearance of anti-PLA2R antibodies post-therapy significantly increased remission chances (RR=2.86).
• Negative gPLA2R also predicted a greater possibility of remission (RR=1.30), with negative anti-PLA2R correlating with complete (RR=1.65) and spontaneous remission (RR=1.93).

Conclusions:

• Absence of anti-PLA2R antibodies or gPLA2R may indicate a higher probability of achieving remission in PMN.
• Anti-PLA2R and gPLA2R serve as valuable biomarkers for predicting clinical outcomes.
• These biomarkers can aid in predicting patient response to immunosuppressive therapy in PMN.